When Mary LaPalme fell down the stairs of her Milton home last September, she didn’t feel any pain.

“It was silly,” she said. “I just remember coming to the bottom and [thinking], ‘What happened?’”

That’s when she caught sight of her mangled ankle. Broken in three spots, it required a handful of metal plates and rods to mend. After surgery, LaPalme was sent home with strict orders to stay off her feet.

Her doctor gave her another instruction: Call the Visiting Nurse Association.

Laura Roberts, a physical therapist with the VNA, has walked up LaPalme’s drive twice a week for nearly two months.

“There has been a lot to work on,” Roberts mused.

She quietly knocked on the door before letting herself in last Monday, knowing LaPalme’s injury prevents her from moving around quickly.

As she measured a set of vital signs, Roberts asked about new artwork on the wall. With pride, LaPalme confirmed her young grandsons painted the masterpieces.

It was just last year LaPalme moved to Milton from New Hampshire to live with her son and grandchildren. She retired from a job in human services, working with cognitively impaired adults.

“It was easier for me,” she explained. “Everything was easier. But, of course, now it’s been a little hard on [my son].”

When Roberts comes knocking on her door, LaPalme said it removes a burden from her family. Her son works full time, she explained, and now doesn’t have to worry how he will transport her to biweekly physical therapy appointments.

“I can’t get out of the house to get to the car and go any place,” LaPalme said. “Laura and I are going to be working on that over the next several weeks.”

Roberts, a Colchester resident and University of Vermont alumna, has been with the VNA for more than 20 years. Before that, she worked as a physical therapist in a variety of clinical settings across New England.

When she transitioned from clinical to home care, Roberts said she noticed a difference in her patients’ demeanor.

“People are, for the most part, more comfortable at home,” she said. “You see them in the hospital or in rehab and they’re anxious, they want to go home. I get to see them when they’re in their element.”

LaPalme is one of up to six clients Roberts sees per day, all in Milton. The VNA even hired a per diem PT to help Roberts keep up with high demand in the community.

Visits usually hover around the one-hour mark, but Roberts says it’s easy to lose track of time. For clients who live alone, Roberts’ appointments may represent the only chance they have to socialize.

“Some people don’t get to visit a lot,” she explained. “I try to give those people an extra five minutes.”

When folks do have family around, like LaPalme, Roberts said she tries to integrate them into the healing process. She’s given LaPalme’s grandsons some exercises to try alongside their grandmother.

Working in a client’s home gives Roberts a glimpse into their lives. She knows when it might be appropriate to recommend other services. An occupational therapist, for example, can help patients accomplish the daily activities and tasks they need – and want – to do after a disability, injury or illness.

After leading LaPalme on a few laps around the kitchen with the assistance of a walker, Roberts set up an exercise station with items found throughout the house.

She dragged a dining room chair across the carpet and tied a bright yellow resistance band to the wooden backing. Later, she laid a thin towel on the kitchen floor, allowing LaPalme to practice gripping objects with her toes, maneuvers she called low-tech.

Guided by Roberts, LaPalme twisted and turned her ankle through a variety of motions. Some prompted a grimace, and Roberts backed off. Others seemed a bit too easy, and Roberts adjusted the resistance.

“I couldn’t do this when I first started,” LaPalme said, staring at her ankle. “Even this is new, just being able to put my foot down [flat].”

Roberts said throughout the visit, she mentions new benchmarks and reminds LaPalme of her progress.

Remarking on the unseasonably sunny November day, she even offered the prospect of taking the appointment outside, much to LaPalme’s delight.

Staircases leading to her bedroom and to the garage have largely confined LaPalme to the living room couch for several weeks. Being cooped up is LaPalme’s biggest challenge: With two young grandsons, she likes to be on the go.

“I have to remind myself sometimes how far I’ve come,” LaPalme said. “It was harder in the beginning. At least now I can see the light.”

LaPalme says her son took her to Rite Aid just days prior, pushing her through the aisles in her wheelchair.

“Big deal, right?” she said. “But it was a big deal to me.It just made it even stronger, my urge to be able to do that stuff myself.”

LaPalme knows her improvement means Roberts’ visits will eventually come to an end.

“I will miss her, but the idea that I could get into the car and actually drive,” LaPalme said, trailing off.